HTN & HLD drug matrix Flashcards
hydrochlorothiazide MOA
works on distal convoluted tubule to inhibit resorption of Na/K+/Cl -> results in decreased cardiac output and increased water loss
also decreases PVR
hydrochlorothiazide side effects
hypokalemia + lyte abnormalities
-orthostatic hypotension
-hyperuricemia
-may worsen renal insufficiency
-can elevate levels of glucose, cholesterol & tags
hydrochlorothiazide nursing considerations
-watch out for pt’s w/ gout
-give K+ sups & encourage K+ rich foods (potatoes, spinach, kale, beans, tomatoes, banana, avocado)
Furosemide MOA
inhibit the kidney’s ability to reabsorb Na in the loop henle -> more Na in urine which water will follow and increase urine output
water pills
Furosemide side effects
hypokalemia + lyte abnormalities
-dehydration
-hypotension
-ototoxicity
Furosemide nursing consideration
-monitor K+ levels (usually give a sup)
Spironolactone MOA
block the action of aldosterone -> K+ retention & excretion of Na & H2O
Spironolactone side effects
-hyperkalemia
-endocrine effects (deepened voice, period and erectile, hirsutism)
Spironolactone nursing considerations
-usually given w/ other diuretics
-only given PO
metoprolol/propranolol/carvedilol MOA
-increases nitric oxide = vasodilation
-blocks stimulation of beta 1 receptors = decreases HR and contractility
metoprolol/propranolol/carvedilol side effects
bradycardia
hypotension
-fatigue/lethargy
metoprolol/propranolol/carvedilol nursing considerations
-can mask hypoglycemia
-wean when discontinuing to avoid rebound HTN
-hold & call if HR <60 or systolic is <100
propranolol/carvedilol additional nursing considerations
do not give to pt’s w/ lung conditions or asthma d/t blocking of beta 2 receptors in the lungs
clonidine MOA
decrease sympathetic outflow resulting in decreased stimulation of adrenergic receptors (alpha & beta)
clonidine side effects
-drowsiness (give at night, v common)
-rebound HTN
-may worsen pre existing liver disease
clonidine nursing consideration
wean when discontinuing
doxazosin MOA
selective alpha 1 blockage (directly blocks SNS & decreases PVR) -> venous & arterial dilation
doxazosin side effects
-hypotension
-dizzinesss
doxazosin nursing considerations
only use after other meds have failed
captopril/lisinopril MOA
blocks ACE -> inhibits angiotensin 2 & aldosterone secretion (vasodilation & less water retention)
captopril/lisinopril side effects
dry, non productive cough
angioedema w/ racial disparity
-first dose hypotension
-dizziness
-rash
captopril/lisinopril nursing considerations
do not give to pregnant women
-renal insufficiency so use caution w/ renal disease
-hyperK+ risk (esp on K+ sups)
-often give w/ thiazide diuretics
captopril additional nursing consideration
can cause neutropenia -> monitor WBC
losartan MOA
blocks the action of angiotensin 2 after it is formed
losartan side effects
usually well tolerated
-angioedema w/o racial disparities
losartan nursing considerations
-do not give to pregnant women requires contraception use
-use cautiously w/ renal pts
aliskiren MOA
direct inhibition of renin (induces vasodilation, decrease blood volume & SNS and inhibitors cardiac & vascular hypertrophy)
aliskiren side effects
well tolerated
-GI discomfort
-hyperK+ when given w/ ACE (esp in DM pts)
aliskiren nursing considerations
-do not give to pregnant women
-takes several weeks to see full effect due to half life
nifedipine/nicardipine MOA
blocks calcium access to cells causing a decrease in contractility & conductivity of heart (vasodilation of smooth muscles & peripheral arterials)
nifedipine/nicardipine side effects
peripheral edema
orthostatic hypotension
-bradycardia
-headache
-abdominal discomfort
-AV block
nifedipine/nicardipine nursing considerations
best for elderly and African Americans
-can give diuretics for peripheral edema
hydralazine MOA
vasodilator works directly on arterial and venous smooth muscles causing relaxation (decreases systemic & peripheral resistance)
hydralazine side effects
-hypotension
-dizziness, headache, tachycardia, edema, dyspnea, GI upset
hydralazine nursing considerations
can be given with isosorbide to treat heart failure in African Americans
what drug class can you not give to pregnant women
-ACE
-ARBs
-Renin inhibitors
what drug classes do you need to watch for renal pts
-ACEs
-ARBs
-Thiazide Diuretics
statins MOA
inhibits HMG-CoA reductase -> less cholesterol is produced & more LDL receptors are produced to pull cholesterol out of the blood
(also stabilizes plaque & decreases inflammation)
statins effect on levels
LDL: 21-63% decrease
HDL: 5-22% increase
TAGs: 6-43 decrease
statins side effects
myopathy -> rhabdomyolysis (breakdown of muscle fibers & acute kidney failure)
-hepatotoxicity
statin nursing considerations
-2 wks to take effect
-take w/ food
-avoid drugs & alcohol
additional nursing considerations for simvastatin & rosuvastatin
take at night d/t short half life since chol is highest at night
ezetimibe MOA
blocks absorption of cholesterol in the jejunum (dietary chol)
ezetimibe nursing considerations
-not as effective as statins d/t dietary chol
-take w/ statin
-2nd line
nursing considerations before giving HLD meds
-fasting lipid panel
-ALT levels
-CK levels (rhabdo)
-consider secondary causes
what are other meds to treat HLD
-bile acid sequestrants
-niacin
-fibric acid derivative
-fish oil
what drugs have a risk of hyperkalemia
-potassium sparing diuretics
-ACEs
-Renin Inhibitors
